Medicare Plans Florida

Coverage and Benefits

Florida residents are entitled to enroll in the Medicare program once they reach the age of 65 or older. The base plan, which involves Medicare Part A and Medicare Part B, covers you for hospital care and outpatient doctor services, respectively. While Parts A and B, often called Traditional Medicare, are intended to cover the medical needs of most retired persons, they do not cover 100% of all medical costs.

Furthermore, your employment history will determine exactly how much you have to pay for Traditional Medicare in premiums. Part A may or may not be free, depending on your employment history. If you have worked at least 10 years or 40 quarters in the US, then the premium for Medicare Part A will be waived. Otherwise, you will have to pay for Part A. Part B, on the other hand, requires a minimum monthly premium regardless of your employment history. Exact costs can be discovered here.

Medicare Part A (Hospital Coverage)

Inpatient care in hospitals

Skilled nursing facility care

Hospice care

Home health care

Medicare Part B (Medical Insurance)

Services from doctors and health providers

Outpatient care

Home health care

Durable medical equipment

Some preventive services

Medicare Part C (Medicare Advantage)

Includes all benefits and services covered under Part A and Part B

Usually includes Medicare prescription drug coverage (Part D) as part of the plan

Run by Medicare-approved private insurance companies

May include extra benefits and services for an extra cost

Medicare Part D (Drug Coverage)

Helps cover the cost of prescription drugs

Run by Medicare-approved private insurance companies

May help lower your prescription drug costs and help protect against higher costs in the future

Discovering Medicare Plans in Florida

There are more than 3.5 million Floridians enrolled in Medicare at this very moment (3,527,830). Of those beneficiaries, a significant 38% of them (over 1.3 million people) prefer Medicare Advantage. For whatever reason, only 642,266 residents (18%) are supplementing Traditional Medicare with a Medigap policy. The remainder could be supplementing their health care needs through some sort of employer benefits program, or might feel that they do not need any sort of Medicare supplement.

In order to purchase a Medicare supplement policy, you must first make sure that you are enrolled in and receiving federal Medicare benefits. Go ahead and click that link if you are unsure of your benefits status, or have any other questions.

Why is Supplementing Medicare so Important?

To borrow a financial term, supplementing Medicare is a way of “Hedging your bets”. You could take a risk and bet that you won’t actually need to use your Medicare benefits. If you are newly retired and still fairly healthy, this bet might work out for you (financially speaking). But if you are older, or have chronic conditions, protecting your retirement fund and limited budget from many of the out-of-pocket expenses associated with Medicare coverage gaps might be a better strategy. Just look at how much Traditional Medicare could cost you without supplemental coverage:

Medicare Part A Costs

Medicare Part B Costs

$1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services

There are a variety of supplemental plans available for you to choose from. The two major players in the field, Medigap and Medicare Advantage, will be discussed here in this article. Our goal is to give you enough helpful information to get you started on meeting your health care needs.

Option #1: What is Medigap?

The term “Medigap” is a nickname of sorts. The first part – “medi” – references the policy’s connection to Medicare. The latter, “gap”, refers to the gaps in coverage that are problematic with Traditional Medicare, and the fact that Your Medigap policy is designed to protect you from them. There are ten plans total: A-D, F, G, and also K-N. Plans E, H, I and J were eliminated from the program due to the Medicare Modernization Act of 2010. By federal law, all 10 plans offer identical benefits in each state. Someone with a Medigap Plan D policy in Wyoming will have the exact same benefits as someone with a Plan D supplement in Florida – the only difference is the price they will pay, and the company which provides the coverage.

Below are the benefits you can expect from each supplement plan:

Plans

A

B

C

D

F

G

K

L

M

N

Part A Hospital Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Hospital Reserve Days

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Benefit For Blood

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Part B Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

*Co-Pays

Hospice Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Skilled Nursing Facility

✖

✖

✓

✓

✓

✓

50%

75%

✓

✓

Part A Deductible

✖

✓

✓

✓

✓

✓

50%

75%

50%

✓

Part B Deductible

✖

✖

✓

✖

✓

✖

✖

✖

✖

✖

Part B Excess Charges

✖

✖

✖

✖

✓

✓

✖

✖

✖

✖

Foreign Travel Benefit

✖

✖

✓

✓

✓

✓

✖

✓

✓

✓

Preventive Care Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Out of Pocket Limit

None

None

None

None

None

None

$4,620

$2,310

None

None

Co-Pays are $20 per office visit, and $50 per ER visit if not admitted to a hospital.** A checkmark indicates 100% coverage for the specified benefit.

Option #2: What is Medicare Advantage?

Medicare Advantage, Medicare Part C, and ‘Medicare Replacement Policy’ all refer to the exact same thing. Medicare Advantage (or MA for short) is essentially a private Medicare replacement. Instead of getting your claims paid out by Uncle Sam, a private insurer will take over those duties. Legally, though, you will not be losing any Medicare benefits. MA plans have to provide you with the same minimum coverage that you would receive from Traditional Medicare. That is the law.

However, as long as you are getting the bare minimum Medicare benefits, your MA provider can also throw in extras, like vision or prescription drug coverage, in order to sweeten the deal. Many companies do exactly that. Of course, premiums and additional costs will rise to help pay for the extra coverage. In order to balance things out and keep costs low, many MA providers prefer to keep their networks limited. So it’s a tradeoff – you may have access to better coverage at an affordable price with MA, but you may end up having to switch doctors.

Confused about HMO and PPO networks? Basically, they are Mealth Maintenance and Preferred Provider Organizations. Whichever organization your Advantage provider works with will determine what doctors you will be allowed to see.

Top HMO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$0

Leon Medical Centers Health Plans - Leon Cares (HMO)

Health and Drug

$0.00

$0

$0

Humana Gold Plus H1036-054C (HMO)

Health and Drug

$0.00

$0

$0

CareOne PLUS (HMO)

Health and Drug

$0.00

$0

Top PPO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$420

Aetna Medicare Premier Plan (PPO)

Health and Drug

$35.00

$310

$540

HumanaChoice H5415-056 (PPO)

Health and Drug

$45.00

$0

$0

HumanaChoice R5826-074 (Regional PPO)

Health and Drug

$0.00

$150

More about Medigap Supplement vs. Medicare Advantage

Learning the differences between Medigap and Medicare Advantage can be tricky. For this reason, we have provided a quick reference table (below) that outlines some of the important characteristics of each plan. Please familiarize yourself with them now:

Questions

Medicare Advantage

Medicare Supplement

How are the plans funded?

Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.

Your monthly premium takes care of the majority of your expenses.

Do I continue paying for Part B?

Yes

Yes

What does it cost me?

Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.

While each plan does require a monthly premium, many of them are affordably priced.

What does the plan cover?

Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.

All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.

Can I budget my health care expenses?

It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.

Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.

Can my plan be cancelled?

Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.

No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.

Are pre-approvals or pre-certifications required?

Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.

No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.

Can I use any doctor or hospital?

Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.

Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.

Can drug, vision, or dental coverage be included in the policy?

Yes.

No. These forms of coverage must be purchased separately.

Who is this plan type generally best suited for?

If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.

If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Medicare Resources & Contact Information

The information provided here is only the beginning. From this point, you know enough about Medicare supplement policies to start asking around and getting some answers with regard to your personal medical needs. Below is a directory of numbers and Florida Medicare offices you can contact for more information.

Important Medicare-Related Healthcare Terms

HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.

PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.

Co-Pay: Amount of money charged per visit to doctor, specialist, etc.

Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.

Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.